Cardiopulmonary bypass (CPB) plays a central role in pediatric cardiac surgery, yet standardized quality indicators (QIs) specific to pediatric practice remain underutilized across institutions.

A comprehensive review of literature from 2010 to 2025 was conducted using PubMed, Embase, and the Cochrane Library. Eligible studies included randomized trials, observational research, and meta-analyses.

DO₂i > 340 mL/min/m² in neonates and >400 mL/min/m² in infants was associated with a lower risk of acute kidney injury (AKI). Lactate >3 mmol/L predicted major morbidity, while MAP >40–45 mmHg correlated with adequate perfusion. Maintaining Hct ≥25% and a fluid balance within ±5% of baseline also supported improved postoperative outcomes. The integration of real-time multimodal monitoring, including NIRS and venous oxygen metrics, enhances individualized perfusion management.

Adopting and standardizing QIs in pediatric CPB supports early detection of inadequate perfusion and enhances surgical safety. A structured, multimodal QI framework can facilitate institutional benchmarking, improve patient outcomes, and guide future innovation in pediatric perfusion practices.